Managing Stress Effectively After TBI, Part I

Brain injury causes sudden, unexpected, and drastic changes in the lives of survivors and family members. Learning to effectively manage the stress associated with these changes may be one of the greatest challenges faced by family members after brain injury.

What is stress? For most people, stress is that uncomfortable feeling you get when you know there is something you should be doing and you’re not doing it. Stress is often a “vicious circle.” The more a person feels they have to do, and the more that people are telling them what to do — the more stress they feel. People also feel more stress if they worry about failure.

Think of stress as like “carrying a stuffed backpack up a big mountain.” Climbing the first hundred feet, your pack may not seem heavy at all. Though nothing gets added to the pack as you go, the weight seems heavier and heavier as you keep climbing without resting. If you’re not careful, the bag gets so heavy you can’t walk any more. Seriously, intense stress, over time, can have disastrous effects on your health.

Stress is a part of daily life. With or without being touched by brain injury, everyone will face stress at some point in his or her life. Through interviews and surveys, researchers have learned a lot about stress by studying people’s everyday lives. Below is a list of life events that surveys show are rated most stressful.

• Spouse's retirement
• Single parenting
• Moving
• Spouse’s illness
• Change in financial state
• Child’s illness
• Depression
• Raising teens
• Parenting parents
• Child returning home
• Marital separation
• Fired at work
• Chemical dependency

Here is a list of things that we’ve heard from survivors and family members. Do any sound like you or someone you know?

• My mother’s been afraid to leave my father at home since his injury. Sometimes my mom asks me to watch him when she goes out.
• My brother’s drinking problem got a lot worse after his injury. Now he drinks every day.
• To help with finances, we sold our house and moved to an apartment.
• My son was living in a dorm at school before the injury. He lives with us again and we’re not sure when he’ll go back to school.
• We were married for nine years before the injury. Three years after he got hurt, we separated. He’s living in an apartment and I’m living in our home.
• Since my wife’s injury, I am basically raising our 4- and 5-year-old girls by myself. She really can’t handle them alone.
• Frank and I were arguing all the time since the accident. I had to move in with my sister because I couldn’t take it anymore.
• My husband was fired from his job. He prefers to call it “retirement.”

The effects of stress can be sneaky. You may not even notice at first, or you may chalk up the problems to something else. Let’s look at how your life might be affected by stress:

Stress Overload Signs

• Disorganization (forgetting your keys, losing things, making a lot of “dumb mistakes”).
• Daydreaming about spending a few days somewhere, even in the hospital - to sleep, read, be taken care of.
• Trouble making even small decisions (having difficulty figuring out what to wear, feeling stumped about what to have for lunch).
• Feeling depressed (wanting to curl up on a bed, pull the covers up over your head, and sleep for a week).

Still not so sure whether you need to worry about stress? We’ve come up with a brief questionnaire that can help you identify your levels of stress. Get a pencil out and circle the “T” for statements that are true about you or “F” for statements that are not true. Be honest. Nobody’s grading this thing but you.

QUESTIONNAIRE: 13 Item Stress Test.

T F   I have a lot to do.

T F   I have more to do than I can handle.

T F   I’m not being productive.

T F   I’m trying really hard but getting nothing done.

T F   I’m feeling unhealthy.

T F   I can’t afford to take breaks or time off.

T F   I’m pushing myself too hard.

T F   I don’t sleep very well.

T F   Too many people are telling me what to do.

T F   I am not treating people the way I want to be treated.

T F   I feel totally exhausted.

T F   Nobody is happy with what I do.

T F   I can’t stand living like this.

Pencils down! Well? What’s the verdict? If you answered all F’s then you’re stress free or maybe fooling yourself. The more T’s you circle, the greater your level of stress and the more you need to think about taking steps to change. Here are some ideas to help you better deal with stress. Try them out and use the ones that work best for you. Think, talk to other people, and try to come up with more ideas.

• Check your “pressure gauge” often.
• Practice effective problem solving. Brainstorm ways to solve problems and try out different solutions.
• Have a back-up plan.
• Take time for yourself; do things you enjoy
• Tell yourself to relax, breathe slowly and deeply.
• Seek support from trusted friends and family.
• Close your eyes, imagine yourself in a pleasant situation or place.
• Keep up a healthy lifestyle — exercise, eat right, and avoid caffeine, alcohol, drugs, and tobacco.
•  Talk to others about how they cope successfully.

This column was written by Debbie West and Jeff Kreutzer from the VCU TBI Model System Program. For more information about outpatient rehabilitation services and VCU research programs, please contact Jenny Marwitz by phone at 804-828-3704, toll free at 1-866-296-6904, or by email at jhmarwit@vcu.edu.